Impetus for Action 

In discussing community capacity building and community mobilization in youth mental health promotion, this document will focus on the experience of a community whose characteristics mirror those of many rural communities across Canada. What stands out, however, is that this community became determined to confront youth suicide and to engage in youth mental health promotion activities at all levels. The journey into the arena of youth mental health promotion in West Carleton, Ontario is a real-life illustration of how a community can move from feeling paralysed to one that has built community capacity not only to heal, but also to bring about significant change. 

The former Township of West Carleton, Ontario is a large rural community covering over 600 square kilometres. Between December 1995 and September 1997, the community found itself face to face with the issue of youth suicide after losing four of its young people between the ages of 16 and 19. All the youth were either students or recent graduates of the only secondary school in the township. The shock of these deaths was felt throughout the community and the fear and grief associated with that loss became overwhelming. Alarm in the community was also fuelled by the fact that the youth had not been previously identified as what would commonly be defined as "at-risk." One could say that this was a community in crisis looking to make sense of the pain and in search of answers. 

The Western Ottawa Community Resource Centre, West Carleton Secondary School and the Brady Burnette Teen Assistance Fund united in a collaborative partnership to create a shared vision to address youth mental health issues. Along the way, many community members have also joined in this vision. The Community Resource Centre is a non-profit, charitable organization consisting of volunteers, staff and a Board of Directors who, in partnership with local groups and agencies, develop, provide and coordinate accessible community health and social services. 

---

Extent of the Problem 

Community capacity building cannot occur in a vacuum. To help a community come terms with the extent of the issues it is facing, context needs to be provided. Only then can its personal experience be seen as part of a larger issue requiring action. In the case of West Carleton, this meant understanding the reality of the mental health challenges facing its youth, in the context of the West Carleton community as a whole. 

Youth Suicide in the Context of Mental Health Promotion 

Suicide is the second leading cause of death among young people aged 10 to 24 in Canada. Although the suicide rate per 100,000 for the 15 to 19-year-old population has remained relatively unchanged since 1981, since the early 1990s there have been significant increases in the suicide rate among youth aged 10 to14. (Statistics Canada and Health Canada, 1999). 

For the people of communities like West Carleton, the loss of life to suicide represents more than just a statistic. Due to its very nature, suicide sends shock waves throughout entire communities. The grief and loss experienced is even more incomprehensible when it involves children. 

The stigma and shame associated with mental health issues in general and suicide in particular contribute to the formidable task of youth mental health promotion. Engaging communities in a dialogue about a subject that has historically been taboo can be very challenging. Yet statistics, and more importantly the community loss of young people, suggest that we must find ways to increase a community's capacity to address youth mental health issues. The concept of youth mental health promotion in the aftermath of a suicide appears, at first glance, to be preposterous. However, it is precisely at this time that the importance of mental health promotion becomes blatantly clear; postvention becomes prevention. 

Suicide Rate per 100,000
Age	1981	1991	1996	1997	1998
1-14 Years	0.7	0.6	0.7	0.9	2.2
15-19 Years	12.7	13.8	11.5	12.9	12.5
Source: Statistics Canada (1999), Catalogue # 82F0075XCB

What Youth Are Reporting About Mental Health Issues 

Increasingly, we are recognizing the importance of having youth help us define the problem, as well as to have them participate as active partners in seeking innovative solutions to better meet the mental health needs of all youth. 

Information collected by the Youth Net/Reseau Ado program from 1995 to 2002 with close to 10,000 youth in Eastern Ontario and Western Quebec suggest that young people's concerns regarding their own mental health are as salient as the concerns that they express about their physical health. Mental health concerns can range from an overall appreciation of the level of stress in their lives, to recurring feelings of depression and even suicidality. Young women report more concerns in all areas, although the potential for young men to be even more reluctant to report or discuss such issues cannot be overlooked. 

---

Self-Reported Recurring Health Concerns

Source: Youth Net/Reseau Ado (2001) N=9563 

---

Percentage of Youth Disclosing
Suicidal Ideation and Behaviour

Source: Youth Net/Reseau Ado (2001) N=9563 

---

Communities need to understand the issues affecting young people. Mental health promotion activities need to be inclusive and "youth friendly." As previously noted, outcomes of community capacity building include an increase in the leadership potential of youth. It becomes critical that the youth voice be heard and innovative ways be fostered in communities to address mental health promotion that are simply not just scaled-down versions of adult models. 

In West Carleton, a concerted effort was made to understand the mental health issues affecting its particular youth population. Two initiatives were undertaken, including a survey by school guidance counsellors to assess overall concerns reported by the Grade 9 population, as well as mental health focus groups facilitated by Youth Net/Réseau Ado. This resulted in a more individualized reflection of the community and helped to shape the action plan of what resources and supports were needed. 

---

Building Momentum 

Capacity Building Through Tragic Events Response 

"Capacity building places the emphasis on existing strengths and abilities,
rather than being overwhelmed by problems or feelings of powerlessness" 

(HRDC, 1999) 

Communities have rallied around each other in times of crisis for many generations. Over time, communities have become much more open to the formal concept of emotional first aid when a tragedy occurs. Many school boards across Canada have tragic event response protocols. Teams are mobilized and will go right into a school when a tragedy, such a youth suicide, occurs. The goal of response is not to interfere with the existing support systems but to identify grief reactions as a normal response to an abnormal situation. In the case of West Carleton, the ripple effects of the suicide reached much further than the school itself, requiring a much broader scope in order to reach the full range of community members who were affected by this issue. Although unaware at the time, this was the beginning of the community mobilization journey in West Carleton. Communities may vary in their needs depending on the nature of the tragic event. In terms of youth mental health, a community may face an acute crisis such as the one depicted here, or more chronic stressors that call for a concerted community response (e.g. youth crime, substance abuse, peer harassment, violence, racism). 

Immediately after the last suicide, tragic response counselling was made available for all youth and parents and a critical incident debriefing session was held for the school personnel. This was the beginning of the establishment of innovative partnerships between resources already in place within this community and an array of other resources that saw that they too had a role to play at the community level. 

The Community Resource Centre played a key role in both the community response and in the brokering of services. A unique staff position that had been created, just prior to the tragedies - was that of a "youth community developer." This role became one of the important catalysts for the community. In capacity building, a catalyst is "an individual or group who believes change is possible and is willing to take the first steps that are needed to create interest and support" (HRDC, 1999). Ultimately, the catalyst motivates others to join in the shared vision and action plan. The Community Resource Centre engaged youth-serving agencies to provide both support and personnel to create a mental health safety net for the community. The Community Resource Centre also became the coordinating body for the initiatives that would follow. 

"In suicide prevention, as in other fields, needs usually run ahead of knowledge; urgency for service often precedes understanding" (Shneidman, 1970). The collective grief and pain in the community was tangible, with individuals primarily seeking answers. There was an overwhelming sense of the professionals needing to "fix this." In capacity building, finding a common ground to talk about these painful issues at this point seemed very difficult, if not improbable. Educating parents on youth mental health issues was also seen as a key strategy in the process of capacity building. Parents reported that they did not know what to say to their children. One parent even acknowledged that all they could think of was to convey to their youth that they were forbidden to ever harm themselves. This was hardly an interactive discussion on mental health. What becomes clear is that most parents do want to be able to talk to their youth. It is also apparent that their own perceptions of mental health issues, including stigma and shame, prevent them from even knowing where to begin. 

Parents were invited to a debriefing meeting at the school to further discuss these issues. Both the school and the Community Resource Centre, with participation of the Children's Hospital of Eastern Ontario (CHEO) mental health professionals, facilitated this meeting. There were many youth service providers in attendance as "gatekeepers" in case parents needed individual counselling. In terms of defining community assets, this was the advent of service providers working in unison to support a community. This would become the model by which we would respond to every community tragedy affecting youth. 

Outcomes of community capacity building involve expanded intuition on what to do, when to do it and when to quit (HRDC, 1999). In the West Carleton community, an understanding began to grow, followed closely by a commitment from community leaders, that they had to find a way to talk about youth mental health. There was also willingness and even a determination to take the risks to do things differently. 

This mobilization effort clearly emphasized the need to include as many members of the community as possible. Although the school remained at the core with students, teachers and parents being included, there was a clear appreciation that other members of the community also were experiencing the loss and needed to be included in the community healing. The post-trauma reactions in the community and the high level of grief and anxiety needed to be addressed. In addition, service providers were seen both as resources as well as community members themselves. 

Community development and capacity building happen, more often than not, when a crisis occurs and the community is left with no choice but to respond. Although limited prevention and postvention activities occurred after each of the suicides, the community involvement remained relatively low profile until the last two suicides occurred one month apart. It was not that community members did not care about the losses but that they did not feel they could do anything about it; they did not even understand it. 

Creating a Shared Vision 

In responding to a community crisis, efforts must move from an initial phase where the emphasis is on responding to the acute need to a second phase where the community is pushed to look forward. The opportunity must be created or facilitated whereby community members can engage in a dialogue to shape their vision for a healthier community. Efforts should be made to engage all key community members as early in the process as possible. 

In the wake of the tragedies and to further engage in a dialogue regarding youth mental health issues, a community forum on youth suicide was organized. Participants included youth, parents, police, service providers and community members. Initially, the idea for the forum was to bring in an "expert" on youth mental health issues. The organizing group of youth and service providers deliberated this plan. If there was to be "buy-in" from the community and a true ownership of youth issues, this did not seem to be the logical direction to take. The forum was to become a starting point in a process to develop an action plan for the community. "When a participatory process is sincerely desired, and individuals and organizations believe they are being listened to and included, you will have gone a long way to building community ownership, support and legitimacy"(HRDC, 1999). Everyone at the forum was on an equal playing field. The philosophy was that each person there that evening had something to contribute. Youth were also central to the design and implementation of the forum, as they were in the initiatives that followed. The legitimacy of youth capacity was reinforced from the onset. 

The goal of the forum was to bring together diverse parts of the community to continue the dialogue and maintain the momentum that had been established through the tragic event response initiatives. (Often, after a tragedy an immediate increase in activity and support occurs that dissipates over time.) The forum was advertised both in the community and at the school. There were also several newspaper articles that appeared before and after the forum and the local television stations carried the story. 

After setting the stage for the evening, the participants broke off into small groups; each had a youth and an adult facilitator who had been briefed on the risk factors associated with mental health issues. The questions to the community became simply: 

• What do you think are the factors contributing to youth suicide?
• What as a community do you think we can do about it?

These sample questions were developed to assist the community to identify the problem and to think about how it could organize itself to respond to the problem in a concerted way. The two simple questions can be used in many other types of community forums to address any youth issues. For example, what are the factors contributing to vandalism? substance abuse? bullying? peer harassment? dating violence?…and What as a community can we do about it?  The key to community capacity building is in both the asking and, ultimately, in the responses. Although the experts have a wealth of knowledge regarding the global concepts and strategies that can be used, they may not know the appropriate solutions as every community has its own unique characteristics, strengths, resources and ideas. Accordingly, a partnership must be forged between the community of experts and the experts on their own community. 

Bringing members together to create a shared vision automatically validates that they themselves have innate knowledge and solutions to address mental health issues. People became drawn into a problem-solving model rather than being immobilized by past events. This becomes evident in looking at the two themes that emerged from the community: 

• Education and Awareness Regarding Youth Mental Health Issues 
• Resource Development Within the Community 

Conceivably, the "experts" could have converged and come to the same conclusions. What would have been missing, and what is absolutely critical in community capacity building and ultimately mobilization, is that it be the community's vision. West Carleton began to create a shared vision to address mental health issues in a way that tapped into its own capacity. This went well beyond the initial focus on youth suicide, stretching to encompass a global conceptualization of community-based mental health promotion. 

After the forum, an extensive effort was made to reach out to the community to discuss youth mental health issues. This included public education talks to service clubs, sporting associations, schools, parent groups, business organizations, etc. As well, resource lists identifying all youth-serving agencies were posted in churches, community centres and recreational complexes. By acting on these ideas, community members were able to identify how their ideas could be translated into action. In this way, the entire process gained credibility, reinforcing continued buy-in at the community level. Clearly, the definition of community had extended well beyond the walls of the school where the impact of the tragedy had initially been felt most acutely. Community members were moving from feeling like nothing could be done to organizing public education on youth mental health issues. The community began using its existing networks to promote youth mental health. 

[Table of Contents] [Next]